Post on 23-Mar-2022
transcript
Clair Mellenthin, LCSW, RPT-S
Director of Child and Adolescent
Services
Wasatch Family Therapy
7084 South 2300 East suite 215
Salt Lake City, UT 84121
(801) 944-4555
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Clair Mellenthin 2018
Attachment defined
• What is attachment?
• An emotional bond
• “A lasting psychological connectedness between human beings” -John Bowlby
• Attachment Spectrum
• Key Concepts
• Safe Haven
• Secure Base
• Proximity Maintenance
• Separation Distress
Clair Mellenthin 2018
“Keeping precious others close is a
brilliant survival technique wired in
our evolution for survival.”
John Bowlby
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Key concepts:
• Secure Base –
The attachment figure
serves as home base that
provides the confidence
to explore the world.
Clair Mellenthin 2019
This Photo by Unknown Author is licensed under CC BY-SA
• Safe Haven -
Finding comfort and safety
in attachment figure to
calm anxiety in the face of
threat.
Clair Mellenthin 2019
This Photo by Unknown Author is licensed under CC BY-SA
• Proximity Maintenance –
The desire to be near attachment figure to provide security and emotional soothing.
Clair Mellenthin 2019
This Photo by Unknown Author is licensed under CC BY-SA-NC
• Separation distress –
Anxiety when separated from primary
attachment figure
Clair Mellenthin 2019
This Photo by Unknown Author is licensed under CC BY-NC-ND
Attachment needs:
•Physical touch
•Emotional closeness
•Acceptance
•Unconditional love
•Safety
•Security
•Play
Clair Mellenthin 2018
Secure attachment
• Characteristics
• Confident that caregiver will
meet your needs
• Appropriate distress when
separated
• Tolerate absences of
attachment figure
• Capable of being soothed
upon reunification
• Moves on to engage in tasks
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Baby powder handprints
• Supplies:
• Lotion
• Baby powder
• Black construction paper
• Example Questions:
• Tell me about your favorite memory of these little, chubby baby hands
• What is your favorite memory about these little, messy toddler hands
• What are your favorite things these big kid hands can do now
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Insecure Attachment
•Characteristics
•Distress upon separation
•Unsure if parent would return
•Clingy or angry upon reunion
•Difficult to soothe
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Feeling Monster Box
• Supplies:
• Empty Kleenex box
•Paint, stickers, etc
• Egg carton (empty)
• Emotions Chart
• Directions:
• 1. Family chooses emotion
• 2. Paint/decorate monster
• 3. Feed monster when
emotionally charged
Clair Mellenthin 2018
Avoidant Attachment
• Characteristics
• Showed psychological distress
but showed little emotion on
separation or reunion
• Unsure if emotional needs will
be met
• Focused on tasks during
separation and reunions
• Attempt to deactivate
attachment system
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The Family Self-Esteem Game
• Purpose:
• To build each family member’s self- esteem, respect, and positive self-talk.
• This also enhances relationships as each member is able tovalidate the other person’s personal resiliency, resourcefulness, and improves communication.
• Supplies Needed: Sharpie, balloons
Clair Mellenthin 2018
Questions
•What’s something you are proud you can do?
• Tell about a time you were able to do something
difficult
• Tell about a time you felt proud of yourself
• Tell about a time you were nice to someone
• Tell about a time that you helped yourself feel better
• Say Something nice to someone else in the room
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Disorganized Attachment
• Characteristics
• Seeking closeness and
avoidance of closeness
• Traumatic experience
• Others as source of fear
AND solution to fear
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The Walled-Off Heart Intervention –by Holly Willard• Supplies:
• Paper & marker
-or-
• Sandtray, cookie cutter
hearts, fences
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Tangled Up In Knots
• Once family is untangled, explore what
it feels like to have space and still be
connected together
• Object lesson: Tangled up hands
represent enmeshed, anxious family
systems. Healthy, secure families are
represented by the circle that is
connected but maintains autonomy
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• Instructions:
• Family stands in a circle facing each
other.
• Instruct them to put all their hands in
the middle of the circle and grab any
hand.
• Once everybody is holding hands
(tangled up) explore what this feels like
• Instruct family members without letting
go of each others hands to untangle
themselves
Goals of Attachment-Centered Play Therapy
• First assess the attachment needs of the family
•Does the family need to
SEPARATE AND INDIVIDUATE = ENMESHED
OR
•Does the family need to
COME TOGETHER AND GROW CLOSER =
AVOIDANT/WITHDRAWN
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• Second goal is to identify the attachment wound or
“rupture”
• Third goal aims to strengthen or repair parent-child
attachment bonds and improve family communication.
•As the normative secure base is restored, parents
become a resource to help the child cope with stress,
experience competency, and explore autonomy.
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Understanding Attachment Ruptures
• What causes wounding or rupture?
• Death
• Divorce
• Abuse
• Neglect
• Separation
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Grief
• Deep and poignant distress caused by or as if by bereavement
• Deep sorrow, especially that caused by someone's death.
• Deep mental anguish, as that arising from bereavement.
• A source of deep mental anguish.
• Something that causes keen distress or suffering
• synonyms: sorrow, misery, sadness, anguish, pain, distress, heartache,
heartbreak, agony, torment, affliction, suffering, woe, desolation,
dejection, despair
• Merriam-Webster Dictionary, Google, The Free Dictionary.com
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• “Children grieve in cycles. For example, they may be more inclined to play and divert their focus from the death when the death is recent and parents are grieving intensely. More than adults, children need time to take a break from grief. It is important to know that it’s okay to take a break. Having fun or laughing is not disrespectful to the person who died; this is a vital part of grieving, too. “
• (Dougy center.org)
Clair Mellenthin 2018
Different types of grief
• Complicated grief is characterized by an inability to accept the death occurred,
denial and avoidance of reminders related to the death, an irrational sense of longing
to be with the deceased person, and persistent and intrusive thoughts about the
deceased (Dickens, 2014).
• A parent who is experiencing complicated grief may experience these symptoms in
addition to intense distress at reminders of the deceased, demanding that family
members do not speak of the deceased or their death in any way, an impairment in
the ability to take care of self and others, as well as significant separation distress
(Mancini & Bonanno, 2012).
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• Delayed grief occurs when the typical grief responses occur weeks, months or even
years after a death has occurred.
• Absent grief occurs when grief is inhibited, denied, or there are no external symptoms
of grief, and no external signs of the grief process observed
• Unresolved or chronic grief occurs when grief is unending, prolonged, and incomplete.
The parent or child is unable to recover from the loss of their relationship and does not
find resolution to their pain or an integration of the deceased into their everyday life
and functioning. They remain stuck in the immediate attachment response of despair
and the attachment goal to re-establish proximity to the deceased (Field, 2006).
Clair Mellenthin 2018
• Repairing and restoring the bonds of connection and attachment between
parent and child following the death and loss of a loved one is a critical
component of healthy grieving. A child’s internal working model of love and
belonging guides them in understanding loss, responding to loss, and ultimately integrating the loss they have experienced into their life narrative.
The nature of attachment prior to loss is also important to understand and
nurture. A securely attached child will still experience some feelings of fear
and insecurity following a death, as this is developmentally appropriate.
However, they do not need to detach from their emotions and
compartmentalize their grief, as their parent has the capacity to hold and
understand them, to nurture throughout the grieving process, and to is able to remain consistently available.
Clair Mellenthin 2018
Shaving Cream Feelings
Supplies
• Shaving Cream
• Food coloring
• Bowls
• Spoons
• Paintbrushes (optional)
• Paper
Clair Mellenthin 2018
Tear Soup
Supplies
• Tear Soup Book
• Pot
• Long spoon
• Play food (vegetables, etc)
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ACPT Treatment
• Goal is to strengthen family relationship to work through and address
challenges
• EVERYONE meets with the therapist
• Parent and child work together in therapy to address challenges through play,
talking, art, experiential activities
• Children that have experienced trauma, abuse and neglect need the loving
support and presence of their parent(s) in therapy to help them feel safe, learn
new things and enhance the parent-child relationship.
• The therapist will have some parent-only time with the goal of supporting parents and clarifying & enhancing the therapy outcomes.
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More ACPT Interventions
•Sticking Together
•Measuring with Licorice
•Feeling Charades
•The Nurturing Game
•Communication Blocks
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Family Music Video Technique
• Family chooses song that represents their family or an issue they are struggling
with/resolved
• Create music video using puppets, props, dress-ups, etc
• Watch video together in session to discuss family themes, rules, roles, etc.
Clair Mellenthin 2018
Nurturing Spoons Intervention
• Supplies:
• 3 ft long ¼” wooden dowel with a
spoon taped onto one end and a
piece of colored duct tape taped on
the other end
• M&M’s or Skittles
• Bowl
• Ask family to form a circle. Give each
family member a “spoon”. Place bowl
of candy in the middle.
• Family members try to eat candy using
their spoons. Goal is to eat 2 spoonfuls
using only 1 hand on the taped area of
spoon
• Only way to eat candy is to feed each
other (family members need direction)
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Love Circle: Evangeline Munns in
Supervision Can be Playful
• Instructions
• Family forms circle. One person chooses to sit in the middle of circle.
• This person faces each person while they say something positive without talking
• Take turns until everybody has had a chance to sit in the middle and receive positive
statements
• Explore how it feels to receive praise, how difficult it can be, especially when positive
comments don’t fit in with our self-image & attachment wounds
Clair Mellenthin 2018
Baby Memories : Evangeline Munns in Supervision
Can be Playful
• Instructions:
• Form an inner circle standing and facing each other
• Form an outer circle standing and facing inner circle
• Whisper to the person in front of you what you would have liked to hear as a little baby
• When done, move to the next person and whisper the same sentence or something
new
• Reverse circles and repeat
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Bibliograghy/Resources
• Baggerly, J; Bratton, S. Building a firm foundation in play therapy research: Response to Phillips (2010). International Journal of Play Therapy, Vol 19(1), Jan 2010, 26-38.
• Bowlby, J (1979). The Making and Breaking of Affectional Bonds. London: The Tavistock Institute
• Bowlby, J. (1969). Attachment. London: The Tavistock Institute.
• Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.
• Bowlby, J, Ainsworth, M., Boston, M., & Rosenbluth, D. (1956), The effects of mother-child separation: A follow-up study. British Journal of Medical Psychology, 29, 2 11-247
• Bratton, S., Ray, D., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: A Meta-analytic review of the outcome research. Professional Psychology: Research and Practice, 36(4), 376-390
• Goodyear-Brown, Paris (2005). Digging for Buried Treasure 1 & 2 Workbook
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• Gerstein, J.S. (1999). Sticking Together. Experiential Activities for Family Counseling.
• Johnson, S. (2004). The Practice of Emotionally Focused Couple Therapy. New York: Brunner-Routledge.
• Lowenstein, L. (2006). Creative Interventions For Children of Divorce
• Moles, K. (2003). Strategies For Anger Management
• Mellenthin, C. (2013). My Many Colors of Me Workbook
• Mellenthin, C. (2018). Play Therapy: Engaging and Powerful Techniques for the Treatment of Childhood Disorders. Eau Claire, WI: Pesi Publishing
• SAMHSA’S National Registery of Evidence-based Practices : Attachment-based Family Therapy www.nrepp.samhsa.gov
• Seigel, D & Bryson, T. (2012). The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s Developing Mind.
• Theraplay Institute: Theraplay Activities Flip Book (2004).
Clair Mellenthin 2018